Clinical Observation Of Vesicoureteral Reflux After Ureteroscopy(Report Of 40 Cases)

Ureteroscopy has developped for several decades,and It has became a rutine method for clinical diagnosis and thrapy.A variety of complications happened along with the developping,include discomfort,reanal colic,urinary infection,perforation,stricture,and so on. Vesicoureteral reflux(VUR) was reported as a late complication by some studies from western contries.But a few other studies considered it as just an early complication.Till now,it has not been investigated in China.There has been a great progress in urerteroscopy these years,and incidence of many complications has decreased dramatically.We chose 40 patients prospectively with ureteral calculi via transurethral lithotripsy using the rigid ureteroscope between March 2007 to March 2008.Micturae Cystourethrography(MCU) was examined before and after the surgery respectively.Through the comparison of the MCU we wanted to observe the VUR after ureteroscopy and discuss the possible mechanism. Objective:To observe the VUR after ureteroscopy and discuss the possible mechanism between VUR and ureteroscopy.Cases and Methods:40 patients udergoing ureteroscopy were chosen randomly,using Olympus8.0~9.8F ureteroscope.36 of them were diagnosed as ureteral calculi preoperatively,and 4 of them were underwent ureteroscopy just for inspection.The ureteroscope was inserted via uretha into bladder and the ureterl orifice was found.A catheter was placed into the ureter and then with the irrigation the ureteroscope was progressed along the catheter into the ureter till the calculi.After ureteroscope enter the orifice,the irrigation was turn down or shut down.The calculi was extracted into small segments with lithotripter. Adequate segments were taken out of the ureter to the bladder or out of body.At the end of the operation,a 6～7F double "J" catheter was placed into the ureter for 3～5 weeks.MCU was examined preoperatively and postoperatively,and the first postoperative MCU was progressed soon after the catheter pulled out.If the first time we find VUR,we can reexamine it 3～6 months latter.Results:All the operations were successful,and no severe complicatin happened.We didn't find VUR in the preoperative MCU. 1Ⅰdegree VUR was found in the first MCU after operation.5 months latter we reexamined this patient and find the VUR was disappeared.Conclusion:These results suggest that early vesicoureteral reflux after ureteroscopy can happen rarely and it is low-grade and temporary.For the operation can not destroy the main mechanism,there will not be long-term vesicoureteral reflux.So it's not necessary to make MCU as a routine follow-up item.